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As treatment options evolve, keeping your blood sugar under control is becoming safer and easier. Learn about new advances in medications for diabetes.

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Thanks to the latest generation of diabetes treatments, there are entirely new approaches to treating type 2 diabetes. People with diabetes and their doctors now have the opportunity to customize diabetes treatment plans to best manage blood sugar and reduce the risk of complications because of several new classes of recently approved diabetes medications.

“All of the new drug classes attack a different diabetes problem,” says George Grunberger, MD, chairman of the Grunberger Diabetes Institute and a clinical professor at the Wayne State University School of Medicine in Detroit. “But you can also mix and match, combining agents from different classes to get additional treatment benefits.”

How Diabetes Treatments Work

People with type 2 diabetes have elevated blood sugar (glucose) levels because their bodies can’t make enough insulin or process it the way they should to keep their blood sugar at healthy levels. The goal of type 2 diabetes treatment is to keep blood sugar under control to reduce the long-term risk of complications from the disease, such as heart disease, kidney failure, and blindness.

The first diabetes drugs, such as injected insulin and sulfonylureas, attacked the problem by increasing the amount of insulin in the body to help control blood sugar. As researchers have learned more about how the body processes glucose, new diabetes treatments have emerged.

For example, one of the most popular traditional types of diabetes drugs, biguanides, works by reducing the amount of glucose produced by the liver and increasing insulin sensitivity. The latest diabetes treatments take that approach one step further by targeting glucose metabolism in the kidneys and other organs.

“The mechanism of action is different for each medication class,” says Enrico Cagliero, MD, an associate professor of medicine at Harvard Medical School and an associate physician at the Massachusetts General Hospital Diabetes Center. “But the end result with all of them is to lower blood sugar levels.”

SGLT2 Inhibitors for Diabetes Treatment

The most recent additions to diabetes treatment are known as SGLT2 inhibitors. This class of oral medications blocks absorption of glucose in the kidneys and allows it to be removed from the body in urine. An advantage of SGLT2 inhibitors versus older diabetes treatments is that they're not associated with hypoglycemia, where the blood sugar becomes too low.

And unlike sulfonylureas, which can trigger weight gain in some people with diabetes, SGLT2 inhibitors can promote weight loss. “Because you excrete sugar through urine, you also get rid of calories and can lose weight,” Dr. Cagliero says.

However, because SGLT2 inhibitors increase the amount of sugar in urine, they can also increase the chance of bladder and yeast infections and can make people thirstier, says Celia Levesque, RN, a certified diabetes educator and an advanced practice nurse at the University of Texas MD Anderson Cancer Center in Houston.

DPP-4 Inhibitors and GLP-1 Receptor Agonists for Diabetes Treatment

Two new classes of diabetes treatments that work in a similar manner are DPP-4 inhibitors and GLP-1 receptor agonists and are available only by injection. They breakdown an enzyme called GLP-1, which is produced by the pancreas to regulate glucose in the body.

An advantage of these drugs is that they can also promote weight loss, which can help with diabetes management. Side effects of the drugs include nausea and low blood sugar, especially when used in conjunction with a sulfonylurea medication.

Incretin Mimetic Drugs for Diabetes Treatment

Another relatively new class of drugs is incretin mimetic drugs. These medications mimic incretin hormones normally produced by the body to trigger the release of insulin after eating. These drugs also help suppress the liver’s glucose output to keep blood sugar under control.

Like other new classes of diabetes medications, incretin mimetic drugs can help promote weight loss. Side effects may include nausea, and the U.S. Food and Drug Administration is investigating a possible link between these drugs and inflammation of the pancreas and precancerous changes in the pancreas.

Cagliero says that, in some cases, these new diabetes treatments are less powerful than older diabetes drugs. “But we know that diabetes isn’t well-controlled in more than half of people with the disease, so there’s a need for new medications that different people can take,” he says. “Now we can look at which medications would be best for more individualized treatment.”

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